Australian Government Department of Health
National Cervical Screening Program
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National Cervical Screening Program Renewal


See below for information on:

Renewal Background

What

  • The Renewal is a strategy for reviewing the policy and operation of the National Cervical Screening Program (NCSP).
  • The aim of the Renewal is to ensure that all Australian women, human papillomavirus (HPV) vaccinated and unvaccinated, have access to a cervical screening program that is acceptable, effective, efficient and based on current evidence.

Why

  • The science of cancer is one of the most rapidly changing areas in health and while the success of the NCSP cannot be disputed, the environment in which the program operates has changed.
  • Since the introduction of the NCSP in 1991, there is new evidence about the optimal screening age range and interval; the HPV vaccine has become available; and there have been developments in new technologies for the early detection of cervical cancer.

Who

  • The Standing Committee on Screening (SCoS) of the Australian Health Ministers’ Advisory Committee (AHMAC) is overseeing the Renewal and a Renewal Steering Committee is guiding the process.
  • The Standing Committee on Screening is a jurisdictional committee. The Renewal Steering Committee is comprised of cervical screening experts in the fields of gynaecological oncology, pathology, cytology, epidemiology, general practice and nursing as well as Commonwealth and state and territory government representatives and a consumer advocate.
  • Input and feedback is also sought through a Partner Reference Group that is open to all stakeholders including industry, health professionals and consumers.

How

  • The Renewal commenced in November 2011 and is:
    • Assessing the evidence for screening tests and pathways, the screening interval, age range and commencement for both HPV vaccinated and non-vaccinated women.
    • Determining a cost-effective screening pathway and program model.
    • Investigating options for improved national data collection systems and registry functions to enable policy, planning, service delivery and quality management.
    • Assessing the feasibility and acceptability of the renewed program for women.

When

  • The assessment of the evidence and economics of potential screening pathways, tests and intervals is now complete and was considered by the Medical Services Advisory Committee (MSAC) on 4 April 2014.
  • It is anticipated that any changes following agreement by governments will not be implemented prior to 2016.

Medical Services Advisory Committee recommendations

The MSAC recommendations build upon the world’s first national school-based HPV vaccination programme by recommending the establishment of the world’s first national cervical screening programme, using a primary HPV test, to prevent cervical cancer. They also provide an opportunity to further reduce incidence and mortality from cervical cancer.

The Assessment Reports considered by MSAC are below (and are to be read with the two Statements dated 13 June 2014 and 26 June 2014). Statement 13 June 2014 (DOCX 15 KB) | Statement 13 June 2014 (PDF 257 KB)
Statement 26 June 2014 (HTML) | Statement 26 June 2014 (PDF 255 KB)

Executive Summary (DOCX 1.25MB) | (PDF 1.41MB)

Review of Evidence (DOCX 3.24MB) | (PDF 4.93MB)

Modelled evaluation (DOCX 20.6MB) | (PDF 12.2MB)

Errata - 9 April 2014 (DOCX 595KB) | (PDF 1.55 MB)

Errata - 15 May 2014 (DOCX 47KB) | (PDF 110 KB)


The MSAC public summary documentation including the recommendations is available on the MSAC website.

The MSAC recommendations include:
  • five-yearly cervical screening using a primary human papillomavirus (HPV) test with partial HPV genotyping and reflex liquid-based cytology (LBC) triage, for HPV vaccinated and unvaccinated women 25 to 69 years of age, with exit testing of women 70 to 74 years of age;
  • self-collection of an HPV sample, for an under-screened or never-screened woman, which has been facilitated by a medical or nurse practitioner (or on behalf of a medical practitioner) who also offers mainstream cervical screening;
  • invitations and reminders to be sent to women 25 to 69 years of age, and exit letters to be sent to women 70 to 74 years of age, to ensure the effectiveness of the program; and
  • the de-listing of the Medicare Benefits Schedule (MBS) items for the existing cervical cancer screening test MBS items over a 6 to 12 month transition period.
The recommended changes to the Medicare Benefits Schedule (MBS) will require consideration by the Australian Government. Other changes to the National Cervical Screening Program, including registry functions, would be for consideration by the Australian Health Ministers’ Advisory Council (AHMAC).

Key Information

The MSAC recommendations

  • The Medical Services Advisory Committee (MSAC) has recommended to the Australian Government that a new ‘cervical screening test’ should replace the current Pap smear.
  • The new cervical screening test detects human papillomavirus (HPV) infection, which we now know to be the first step in developing cervical cancer.
  • Following a comprehensive review of the current evidence for cervical screening, MSAC has recommended for both HPV vaccinated and unvaccinated women that:
    • an HPV test should be undertaken every 5 years;
    • cervical screening should commence at 25 years of age;
    • women should have an exit test between 70 and 74 years of age; and
    • women with symptoms (including pain or bleeding) can have a cervical test at any age.
  • An HPV test every 5 years is more effective than, and just as safe as, screening with a Pap test every 2 years.
  • An HPV test every 5 years can save more lives and women would need fewer tests than in the current 2 yearly Pap test program.
  • Pending policy decisions, it is anticipated that changes would not be implemented prior to 2016.
  • HPV vaccinated women would still require cervical screening as the HPV vaccine does not protect against all the types of HPV that cause cervical cancer.
  • Until any changes are implemented women should continue to have two yearly Pap tests.
  • Further information on the MSAC recommendation may be found at: MSAC website.

The Human Papillomavirus and cervical cancer

  • HPV is a virus that is a very common cause of infection in humans, similar to the common cold. Most women get it at some point in their lives. There are many types of HPV infections, and most of them clear up by themselves without causing any problems.
  • HPV is transmitted through sexual activity. HPV infections are very common in young women and men in the early years of sexual activity.
  • HPV infections are transient and will usually clear by themselves within 1-2 years. If the infection is not cleared, there is an increased risk of developing cervical cancer.
  • Persistent HPV infections can cause abnormal cell changes that may lead to cervical cancer. However, this usually takes a long time, often more than 10 years.
  • HPV is the virus that causes more than 99 per cent of cervical cancer.
  • The HPV vaccine protects against the most common strains of HPV, accounting for approximately 70% of cervical cancers.

The HPV test

  • The procedure for collecting the sample for HPV testing is the same as the procedure for having a Pap smear. A doctor or nurse would still take a small sample of cells from the woman’s cervix to send away to a laboratory to be examined.
  • If HPV is found (HPV positive), further testing (cytology) would automatically be done on the same sample to check if any abnormal cells are present (like the current Pap test), with no need to go back for a second test.
  • If a woman doesn’t have the virus (HPV negative), she would be invited to rescreen in five years.
  • Clinical trials have demonstrated that screening with an HPV test every five years is more effective than, and just as safe as, screening with a Pap test every two years.
  • Cervical screening is provided by doctors and nurses in general practices, family planning clinics, women’s health centres, rural and remote clinics, and Aboriginal and Torres Strait Islander health services.

Women younger than 25 years of age

  • The recommendation to commence cervical screening at 25 years of age is based on evidence that shows:
    • cervical cancer in young women is rare;
    • screening women younger than 25 years of age has not changed the number of cases of cervical cancer or deaths from cervical cancer in this age group;
    • commencing screening at 25 years of age would prevent investigation and over treatment of common cervical abnormalities in young women that usually resolve spontaneously;
    • HPV vaccination has already been shown to reduce cervical abnormalities among women younger than 25 years of age and will continue to reduce the risk of cervical abnormalities in this age group.
  • Until any changes are implemented, women younger than 25 years of age should discuss their individual circumstances with their cervical screening provider prior to making a decision to screen.

Women over 69 years of age

  • Women between 70 and 74 years of age who have had a regular screening test would be recommended to have an exit HPV test before leaving the cervical screening program.
  • Women older than 69 years of age who have never been screened or have not had regular screening tests should have an HPV test if they request screening.

When are changes to the screening program expected?

  • The Australian and state and territory governments will consider the operational changes that will be required, prior to making policy decisions.
  • It is anticipated that any changes would not be implemented prior to 2016.

Cervical Cancer Facts

  • In 2009, approximately 770 women were diagnosed with cervical cancer and there were 232 deaths from cervical cancer in 2010.
  • In Australia, 80% of women with cervical cancer have not been screened or have not had regular screening tests.
  • Women of any age who have symptoms should have appropriate clinical assessment which may include a cervical cytology test and an HPV test.

Partner Reference Group

An informal Partner Reference Group, open to anyone with an interest in cervical screening, has been established.

Newsletters

Regular E-newsletters are distributed to inform Partners of the progress of the Renewal. If you wish to join the Partner Reference Group mailing list for E-newsletters please email the Cervical Renewal team at CervicalRenewal@health.gov.au

Consultations

Three PRG forums were held over two days in Sydney and Melbourne on 28 and 29 April 2014. The following presentation was given:

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Page currency, Latest update: 15 October, 2014